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Open Access Research article

A mixed methods descriptive investigation of readiness to change in rural hospitals participating in a tele-critical care intervention

Jane Zapka1*, Kit Simpson2, Lara Hiott3, Laura Langston3, Samir Fakhry4 and Dee Ford3

  • * Corresponding author: Jane Zapka zapka@musc.edu

  • † Equal contributors

Author Affiliations

1 Department of Public Health Sciences, Medical University of South Carolina (MUSC), 135 Cannon Street, Charleston, SC, 29425, USA

2 Department of Health Leadership and Management, MUSC, 151 Rutledge Avenue, Charleston, SC, 29425, USA

3 Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, MUSC, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA

4 Department of Surgery, MUSC, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA

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BMC Health Services Research 2013, 13:33  doi:10.1186/1472-6963-13-33

Published: 29 January 2013

Abstract

Background

Telemedicine technology can improve care to patients in rural and medically underserved communities yet adoption has been slow. The objective of this study was to study organizational readiness to participate in an academic-community hospital partnership including clinician education and telemedicine outreach focused on sepsis and trauma care in underserved, rural hospitals.

Methods

This is a multi-method, observational case study. Participants included staff from 4 participating rural South Carolina hospitals. Using a readiness-for-change model, we evaluated 5 general domains and the related factors or topics of organizational context via key informant interviews (n=23) with hospital leadership and staff, compared these to data from hospital staff surveys (n=86) and triangulated data with investigators’ observational reports. Survey items were grouped into 4 categories (based on content and fit with conceptual model) and scored, allowing regression analyses for inferential comparisons to assess factors related to receptivity toward the telemedicine innovation.

Results

General agreement existed on the need for the intervention and feasibility of implementation. Previous experience with a telemedicine program appeared pivotal to enthusiasm. Perception of need, task demands and resource need explained nearly 50% of variation in receptivity. Little correlation emerged with hospital or ED leadership culture and support. However qualitative data and investigator observations about communication and differing support among disciplines and between staff and leadership could be important to actual implementation.

Conclusions

A mixed methods approach proved useful in assessing organizational readiness for change in small organizations. Further research on variable operational definitions, potential influential factors, appropriate and feasible methods and valid instruments for such research are needed.

Keywords:
Tele-medicine; Rural hospitals; Readiness to change